Screening and intervention for illicit drug abuse - A national survey of primary care physicians and psychiatrists

Background: Illicit drug abuse causes much morbidity and mortality, yet lit tle is known about physicians' screening and intervention practices regardi ng illicit drug abuse. Methods: We mailed a survey to a national sample of 2000 practicing general internists, family physicians, obstetricians and gynecologists, and psychi atrists to assess their screening and intervention practices for illicit dr ug abuse. Results: Of 1082 respondents (adjusted response rate, 57%), 68% reported th at the) regularly ask new outpatients about drug use. For diagnosed illicit drug abuse, 55% reported that they routinely offer formal treatment referr al, but 15% reported that they do not intervene. In multivariate logistic r egression models, more optimal screening and intervention practices were as sociated with psychiatry specialty, confidence in obtaining the history of drug use, optimism about the effectiveness of therapy, less concern that pa tients will object, and fewer perceived time constraints. Conclusions: Most physicians reported that they ask patients about illicit drug use, but a substantial minority inadequately intervene in diagnosed dr ug abuse. Initiatives to promote physician involvement in illicit drug abus e should include strategies to increase physicians' confidence in managing drug problems, engender optimism about the benefits of treatment, dispel co ncerns about patients' sensitivity regarding substance use, and address per ceived time limitations.